Personality Disorders in Teens

A personality disorder is a general term given for a number of mental health conditions that affect a person’s character, social abilities, and emotional reactions. These conditions commonly, though not exclusively, develop in adolescence.

There are several personality disorders that typically fit into one of three clusters. Although they all have distinct features they generally share unhealthy patterns of behavior and disordered cognition. Somebody living with a personality disorder may have their social, personal, school, or college life impacted by their condition.

If left untreated, personality disorders can go on to cause significant distress and difficulties throughout their teen and adult life. Due to the fact that teenagers are still developing physically and mentally, these conditions are often called emerging personality disorders. This reflects the fact that a formal diagnosis may be delayed, even though certain symptoms are present.

Recognizing a Personality Disorder

Although each condition has key defining personality traits, there are some agreed characteristics that help in the diagnosis process. These include:

• Emotional dysregulation
• Disordered thought patterns
• Loss of impulse or, conversely, extremely restrictive behavior
• Difficulties in making and maintaining relationships

Personality Disorder Clusters

The three personality disorder clusters are usually referred to as clusters A, B, and C. Below we will go into some of the symptoms associated with each condition.

Cluster A Personality Disorders

There are three conditions within this group, they share some symptoms and can lead people to behave in ways that might seem strange or confusing to others.

Paranoid Personality Disorder

A young person with paranoid personality disorder is likely to experience significant distrust and suspicion of others. They may believe that others are trying to hurt or trick them. People with paranoid personality disorder are likely to feel attacked easily and don’t trust those around them, leading to difficulties in relationships.

Schizoid Personality Disorder

Somebody living with schizoid personality disorder is likely to be uninterested in making connections with others, preferring to be alone. They may feel that relationships add complexities to their life that they don’t want. Other people may interpret somebody with schizoid personality disorder as cold or numb.

Schizotypal Personality Disorder

Somebody living with schizotypal personality disorder may struggle to form relationships and will find socializing challenging. People with this schizotypal personality disorder may experience significant social anxiety and stunted emotions. Their behavior may seem odd or eccentric to others.

Cluster B Personality Disorders

There are four conditions within this group, they have distinct symptoms but they all at times may lead to highly emotional and unpredictable behavior.

Antisocial Personality Disorder 

This condition is not diagnosed in young people under the age of 18, although some people display indicators of antisocial personality disorder as children and teens, and then go on to receive a diagnosis as an adult. It is thought that children with conduct disorder have a higher chance of developing this condition later on as adults.

People living with antisocial personality disorder are likely to show a lack of consideration for other people. This could be characterized by dishonesty, stealing, aggression, or violence.

Those with antisocial personality disorder may find it difficult to show care or understanding toward others. Furthermore, they may lack consideration for consequences, thus resulting in serious, sometimes legal, trouble.

Common symptoms of antisocial personality disorder include:

• Being unable to learn the consequences of their behavior
• Impulsiveness
• Taking part in behavior that damages themselves, those around them, or their environment
• Dishonesty and lying
• Difficulty attaching emotionally to others
• Aggression or violence

Borderline personality disorder

Borderline personality disorder is also sometimes referred to as emotionally unstable personality disorder. This is a condition that results in the person experiencing very extreme, fluctuating emotions. For somebody with borderline personality disorder, it can be very difficult to calm down once an emotion is triggered.

It can be very difficult for those with borderline personality disorder to have stable relationships due to their unpredictable mood and behavior. They may experience severe depression and suicidal ideation. Some people with this condition will experience episodes of intense distress, and other times of relative calm, where their symptoms abate. Others will experience continuous symptoms of the condition.

Common symptoms include:

• Severely fluctuating and unregulated emotions
• A deep fear of abandonment

• Complex, or unhealthy relationship patterns
• Impulsive or risky behavior
• A lack of sense of self
• Self-harm or suicidal ideation
• Anger or aggression
• Numbness

Histrionic Personality Disorder  

Histrionic Personality Disorder is considered a condition within the Diagnostic and Statistical Manual of Mental Disorders, although some people describe it as a branch of narcissistic personality disorder.

Young people with histrionic personality disorder are likely to display some of the symptoms below. In order to have a diagnosis of histrionic personality disorder, they must have five of the following, and they must persist for at least one year:

• A strong desire to be the focus of attention
• Seek reassurance or approval from others
• Inappropriate behavior including that of a sexual nature
• Fluctuating moods and emotions
• Preoccupation with physical appearance
• Prone to being led or manipulated by others
• May behave in a dramatic way, even about simple matters
• Is likely to misunderstand relationships

Narcissistic Personality Disorder

Young adults with narcissistic personality disorder are living with an extreme version of narcissism. This condition is more common in young people than in adults, affecting more males than females overall. Typically, narcissistic personality disorder begins in adolescence, but it can go on to impact people throughout their adulthood.

Somebody with this condition is likely to have overblown beliefs about themselves, they may believe that they are capable of things that others are not. Narcissists usually look for validation and admiration from others around them and strive to be in control at all times. They may be overly concerned with achievement, success, and power.

Furthermore, narcissistic teens may find it difficult to empathize with others, behaving in ways that serve themselves but not others. They may struggle to keep relationships due to their lack of care and compassion for others.

Underneath these symptoms, people living with narcissistic personality disorder are likely to have deep feelings of insecurity and fear.

Cluster C Personality Disorders

There are three mental health conditions within this group, and all three involve anxious and fearful behavior although they have different manifestations.

Avoidant Personality Disorder

Young adults with this condition are likely to be extremely sensitive to criticism and may be very shy and withdrawn. This tends to lead to isolation and loneliness.

These symptoms usually begin in early childhood, and sometimes dissipate as the child grows. In other circumstances, the shyness, anxiety, and fear of rejection remain through their teens and adulthood. This can make it complicated to distinguish between shyness and a fully developed avoidant personality disorder. For this reason, it is not common to diagnose children with the condition.

Dependent Personality Disorder 

This condition sees young people behave in a particularly clingy and needy way, finding it difficult to consider being alone or looking after themselves.

Young adults with dependent personality disorder typically need others to reassure and encourage them, even for tasks that may seem like everyday events to others. They may be gripped by anxiety or fear at the thought of being alone or doing things by themselves.

Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder is distinct from obsessive-compulsive disorder (OCD) which is an anxiety disorder, although they frequently get mistaken for one another. Obsessive-Compulsive Personality Disorder is likely to display itself with the following symptoms:

• Extremely neat, to a point that if they can’t maintain neatness of themselves or their space they get extremely anxious
• Perfectionism over several areas of their life
• Controlling over their own lives, and others
• May put work before other people, including loved ones
• Extremely restrictive and strict about rules and order

How Are Adolescent Personality Disorders Diagnosed?

Emerging personality disorder diagnoses can be complex given the symptoms overlap with some common behaviors of being a teen or early adulthood. Additionally, for a personality disorder diagnosis, symptoms must be clearly present for a period of time, interfering with the young person’s everyday life, and causing difficulty in normal functioning. This limits the chances of an early diagnosis which can in turn mean treatment is more complicated and drawn out.

Furthermore, some symptoms of teen personality disorders share symptoms of other mental health conditions such as depression or anxiety. Involving the help of a trusted medical professional is crucial for this reason.

What Causes Personality Disorders in Teens?

It’s still not known exactly why teen personality disorders develop, but research suggests that a number of factors including genetics, brain structure, environment, and trauma could all contribute.

• Genetics: It is thought that individuals with a family history of personality disorders are at higher risk of developing one themselves.
• Brain Structure and Function: Research suggests that individuals with some forms of emerging personality disorder may experience structural and functional changes in the brain, particularly in the impulse control and emotion regulation regions. It is still unknown whether these are causal factors for the condition developing or if indeed the changes are a result of the disorder.
• Environment and Childhood: It’s common for people with personality disorders – especially borderline personality disorder – to have a history of trauma, which could include sexual, physical, or verbal abuse, neglect, abandonment, grief, or family mental health issues.
• Sensitivity: People who are particularly sensitive to stimuli such as noise, light, and touch are thought to be more at risk of developing a personality disorder. High reactivity in children can result in withdrawn and nervous personalities which could lead to mental disorders such as obsessive-compulsive personality disorder, avoidant personality disorder, or dependent personality disorder.

It’s important to say that not everybody who experiences the above will go on to develop an emerging personality disorder. On the other hand, some people will develop personality disorders without the above experiences. Mental illness is a widely researched area of health, but there is still a lot we don’t understand about why conditions develop. The good news is, with better and smarter science we know more about these illnesses every day and that means treatment has never been better.

It’s crucial to work with a team of specialists in the case of a personality disorder, given the complexities involved. There is a range of traditional and alternative therapies which can be effective, but receiving care from an unlicensed practitioner can be dangerous and put your child at risk.

Some people will respond well to the first treatment they try, while others will need to persevere with several attempts. The important thing is sticking to your treatment plan and remaining good communication with your doctor and support system.

Treatment for Young People with Personality Disorders

Usually, specialists will advise young people to start with talk therapy in the treatment of emerging personality disorders. How this develops will depend on the treatment center chosen, some people may choose to recover in an inpatient center, while others will choose outpatient. Discussing these options with your family doctor will ensure you go for the most suitable option for your child’s needs.

Treatment is likely to take some time, with some symptoms easing more quickly than others. Certain therapies and medications may decrease the high emotions, depression, and anxiety of these disorders, whereas deep-seated fears and worries will take longer to dissipate.

It’s common for people with personality disorders to live with co-occurring disorders, such as eating disorders, PTSD, depression, borderline personality disorder (BPD), or anxiety. It’s important that this is taken into consideration in the treatment planning process. Conditions such as attention deficit hyperactivity disorder may also be involved.

Help for Teens and Young Adults

Receiving a personality disorder diagnosis can sometimes be a little scary, for the young person and their family and loved ones. But the good news is, there are many ways to support each other through this time. With good communication, compassion, and patience you can learn to adapt to the needs of one another. It’s crucial for the wellbeing of your child, and yourself, that you involve mental health professionals to guide you through the early days of a diagnosis.

A trained medic who has experience in personality disorders will be able to help you and your family understand the condition, learn healthy coping strategies, and identify trigger points. They will be able to offer your young person a safe environment where they can talk about their experiences, share their concerns, and make plans for the future.

Seeking Support

If you are concerned that your child is displaying symptoms of an emerging personality disorder, get in touch with your family doctor. A proper diagnosis is the important first step in your child’s process as without this they are unable to access the support and treatment they need.

There could be additional underlying conditions, either mental or physical, which are contributing to your child’s distress. Seeking support through your local doctor or psychiatric clinic can help you to clarify symptoms and concerns.

Treatment Options

There are a number of treatment approaches that can be used in the case of an emerging personality disorder. Most people respond well to a combination of therapies, but every person is different and it’s important to consider their unique circumstances and needs before formulating a plan.

Most young people will need to attend a treatment center, this could be inpatient or outpatient care depending on their situation. Facilities and therapeutic options vary from center to center, but there are some common treatments and changes which can improve symptoms of personality disorders.

Some of these include the following:

Dialectical behavior therapy (DBT): This therapy is concerned with focussing on the present moment and any emotions that are currently being felt. Through DBT therapy people learn to control difficult emotions that surface, decrease self-sabotaging behavior, manage stress, and improve communication. DBT both works to accept the current situation, and work on improvements for the future. This form of therapy was specifically designed for the treatment of borderline personality disorder (BPD) and it is used commonly for conditions in all three clusters. DBT is often found to be the most effective form of treatment for personality disorders.

Mentalization-based therapy (MBT): This is a form of talk therapy that helps people living with mental illnesses to develop a better awareness of what others around them might be thinking and feeling. In turn, this can improve their communication and relationships, both of which are crucial for good mental health.

Transference-focused therapy (TFP): This treatment focuses on helping people to better identify and understand the root causes of their mental health condition. Clients will work with their therapist to use this knowledge and apply it to their experiences.

Family Therapy: Family therapy can be extremely beneficial for young people living with a personality disorder. These conditions can impact everyone around the person who has been diagnosed and engaging in treatment together can help to heal broken communication pathways. Gaining a better understanding of how and what everyone is feeling can enable you to find strategies to manage together.

Medications: Sometimes medication is used in the treatment of personality disorders, although it cannot cure these conditions, it can ease other symptoms associated such as anxiety or depression.

Healthy lifestyle changes: Ensuring that your child gets adequate fresh air and exercise, quality sleep, a healthy and varied diet, and uses good stress management techniques can aid them in their recovery significantly.

Encourage Everyday Activities

Restoring links with friends and family can be extremely beneficial for the treatment of these conditions. This can support the recovery process and re-establish a sense of normality for your teen. Encouraging your child or teen to engage in activities they once enjoyed can be a good way of establishing structure in their day. This can start with walks in the park, making time to read, and progress onto meeting friends or going to the cinema for example.

Clearfork Academy

At Clearfork Academy, our team specializes in adolescent psychiatry and are experts in youth mental health. We understand the need for age-appropriate treatment and we take this into consideration at every step of the journey. We tailor our programs to the specific needs of you and your child, ensuring the safety, comfort, and health of everyone involved.

Our therapy offerings include family and individual therapy, as well as alternative options such as adventure and music therapy. We believe all young people deserve to live out their youth, mental illness shouldn’t get in the way.

If you would like to hear more about our admissions process, our facilities, or treatment services, get in touch with us today.